Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study

doi:10.1016/j.sleep.2014.05.021

Sleep Medicine

Volume 15, Issue 9, September 2014, Pages 1140-1146

https://doi.org/10.1016/j.sleep.2014.05.021 Get rights and content

Highlights

•
The association between sleep and glomerular filtration rate was investigated.
•
Community-based participants from the CARDIA study wore a wrist actigraph.
•
Glomerular filtration rate was estimated three times over 10 years.
•
Shorter sleep duration was related to higher filtration rates over 10 years.
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Poorer sleep quality was related to higher filtration rates over 10 years.

Abstract

Objective

To determine the association between objectively measured sleep and 10-year changes in estimated glomerular filtration rate (eGFR).

Methods

From 2003 to 2005, an ancillary sleep study was conducted at the Chicago site of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Community-based black and white adults (aged 32–51 years) wore a wrist actigraph for up to six nights to record sleep duration and fragmentation. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI). Participants without history of cardiovascular or chronic kidney diseases, proteinuria, or hypertension at the 2000–2001 CARDIA examination were followed over 10 years (n = 463). eGFR was estimated from serum creatinine (eGFR_Cr) at the 2000–2001, 2005–2006, and 2010–2011 CARDIA examinations, whereas cystatin-C-estimated eGFR (eGFR_Cys) was measured at the 2000–2001 and 2005–2006 examinations. Generalized estimating equation regression and linear models estimated the associations of each sleep parameter with changes in eGFR_Cr and eGFR_Cys, controlling for cardiovascular and renal risk.

Results

Sleep parameters were not related to 5-year change in eGFR_Cys. However, each 1 h decrease in sleep duration was significantly associated with a 1.5 mL/min/1.73 m² higher eGFR_Cr [95% confidence interval (CI), 0.2–2.7], and each one-point increase in PSQI was significantly associated with a 0.5 mL/min/1.73 m² higher eGFR_Cr (95% CI, 0.04–0.9) over 10 years.

Conclusion

In this community-based sample, shorter sleep and poorer sleep quality were related to higher kidney filtration rates over 10 years.

Introduction

Poor kidney function, as measured by estimated glomerular filtration rate (eGFR) [1] , [2] and restricted and poor quality sleep are novel risk factors for cardiovascular disease (CVD) and mortality [3] , [4] , [5] . However, the literature on the relationship between sleep and kidney disease development is scant. A review proposed that sleep disturbances may contribute to chronic kidney disease (CKD) development either indirectly through its influences on diabetes, obesity and hypertension, or directly through the sympathetic nervous system and renin–angiotensin–aldosterone system [6]. Obstructive sleep apnea may also contribute directly to the development of CKD because it is associated with glomerular hyperfiltration, proteinuria, and endothelial dysfunction [6] , [7] . Only one study to date has investigated the relationship between sleep and kidney function among healthy adults without CKD. Results revealed that short self-reported sleep (<5 h) was associated with increased incidence of proteinuria in a large sample of young to middle-aged Japanese adults [8].

The aim of the present study was to determine whether objectively assessed sleep duration and fragmentation, and self-reported sleep quality are associated with change in kidney function. Certain sex and race groups may be at greater risk for kidney dysfunction because the severity of disrupted and restricted sleep varies by these groups [9]. Therefore, the second aim was to determine whether the relationships between sleep and kidney function vary by sex and race.

Section snippets

Study sample and design

From 1985 to 1986, the CARDIA study recruited 18–30-year-olds balanced by age (18–24, 25–30 years), race (self-reported black or white), sex, and education level (<high school, ≥high school) from four US sites. Participants were re-examined approximately every 2–5 years with the latest examination occurring 25 years after baseline (2010–2011). Methodological information for the CARDIA study is provided elsewhere [10]. At the Chicago site, an ancillary CARDIA Sleep Study was conducted in

Participants

Eligible participants did not differ significantly from ineligible participants at the CARDIA Chicago site in age, sex, smoking status, alcohol use, and LDL levels. Ineligible participants (those with prior history of CVD, CKD proteinuria, and hypertension) were significantly more likely to be black, have less education, less income, higher hs-CRP levels, higher BMI, engage in less physical activity, and report more depressive symptoms (data not presented).

Descriptive characteristics

In Table 1, characteristics of the

Discussion

In this community-based cohort of young-to-middle aged black and white adults without a history of CVD, CKD, proteinuria, or hypertension, shorter actigraphy-measured sleep duration and poorer reported sleep quality were associated with statistically significant increases in eGFR_Cr over a 10-year follow-up. The rate of change in eGFR_Cr as a function of sleep duration or sleep quality did not vary over time. The increases were modest in magnitude. The largest increases in eGFR_Cr were associated

Funding sources

The Coronary Artery Risk Development in Young Adults Study (CARDIA) is supported by contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C, and HHSN268200900041C from the National Heart, Lung, and Blood Institute (NHLBI), the Intramural Research Program of the National Institute on Aging (NIA), and an intra-agency agreement between NIA and NHLBI (AG0005). Dr Petrov received training support from AHRQ (5 T32 HS013852-09) and NCMHD (3 P60

Conflicts of interest

Dr Lewis receives research funding unrelated to the submitted work from Novo Nordisk; Dr Glasser receives salary support from AMGEN to evaluate trials for treating elevated LDL-cholesterol.

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2014.05.021.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

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Original ArticleObjective sleep, a novel risk factor for alterations in kidney function: the CARDIA study

Highlights

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Study sample and design

Participants

Descriptive characteristics

Discussion

Funding sources

Conflicts of interest

Am J Kidney Dis

Am J Kidney Dis

J Clin Epidemiol

Am J Kidney Dis

Psychiatry Res

Lancet

Sleep Med Rev

Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population

Am J Epidemiol

Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention

Circulation

Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies

Eur Heart J

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population

J Intern Med

Change in estimated GFR associates with coronary heart disease and mortality

J Am Soc Nephrol

The impact of obstructive sleep apnea on chronic kidney disease

Curr Hypertens Rep

Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study

Am J Epidemiol

Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program

Clin Chem

Original Article
Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study